title: Procalcitonin adds to diagnosis, but does not reduce initial antibiotics in febrile neutropenic children.
abstract: BACKGROUND
  The immune system is suppressed during chemotherapy. This makes diagnosis of severe life-threatening infections more difficult and it also intensifies the clinical course of such infections. Hence, empirical use of broad-spectrum antibiotics is mandatory. We investigated if procalcitonin (PCT) measurement may improve diagnostic accuracy.
  
  
  METHODS
  In a prospective observational study, we included all admissions due to febrile episodes in a cohort of children below 16 years of age. PCT and C-reactive protein (CRP) were analyzed using LUMI test and VITROS CRP slides, respectively.
  
  
  RESULTS
  We recorded 230 febrile episodes in 85 children. Severe systemic infection was found in 61 (27%) of these episodes. PCT performed better than CRP (p value ≤ 0.01). The discriminative power of PCT was significant already from admission. For CRP, discriminative power was significant after 48 hours. The cut-offs for PCT and CRP were 0.4 ng/ml and 336 nmol/ml to achieve sensitivities of 93%. The specificities for PCT and CRP were 45% and 22%, respectively. Severely infected patients were not found, either by PCT or by CRP in four (7%) cases. PCT levels rose in response to infection in the neutropenic population.
  
  
  CONCLUSIONS
  PCT measurement considerably improves biochemical information; however, the sensitivity is too low to safely alter the recommended administration of empirical antibiotics at admission.
authors.affiliation: Department of Anaesthesia, Aarhus University Hospital, Skejby, 8200 Aarhus N, Denmark. david.lodahl@skejby.rm.dk
authors.forename: David
authors.initials: D
authors.lastname: Lodahl
authors.forename: Henrik
authors.initials: H
authors.lastname: Schrøder
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D002097:C-Reactive Protein; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005334:Fever / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007223:Infant; D009503:Neutropenia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; C079903:C-reactive protein (164-173); C000606589:CALCA protein, human; D010446:Peptide Fragments; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide